Consciousness Disorders: Symptoms, Diagnosis, and Treatment

Could you please clarify the issue regarding consciousness disorders?

The individual experienced episodes of tachycardia and a sensation of distortion ten years ago and went to the emergency room.
Similar episodes occurred 4 to 5 times subsequently, but ceased three years ago.
However, since the first episode, symptoms such as fatigue, difficulty concentrating, and dizziness have persisted.
The individual has consulted numerous doctors (including traditional Chinese medicine practitioners) and undergone various tests, including over ten blood tests, more than ten resting electrocardiograms, three exercise electrocardiograms, two portable electrocardiograms, three electroencephalograms, six carotid ultrasounds, five echocardiograms, one CT scan, and two MRIs (the most recent on January 12, 1994), all of which returned normal results.
Following this, the individual was advised to see a psychiatrist and has been on intermittent medication, but the condition remains unstable.
Two years ago, the individual began jogging to improve physical fitness and relieve stress; while there was some improvement in dizziness, fatigue persisted.
On the evening of April 29, while driving from Taipei southward, the individual experienced dizziness and distortion while passing through Toufen.
Upon entering the Tai'an rest area and making a turn, there was a sudden increase in heart rate, followed by shaking hands and feet and a feeling of faintness after getting out of the car.
After resting briefly, the symptoms eased.
This morning (May 4), while conversing with a colleague, the individual suddenly felt extreme fatigue, confusion, and difficulty expressing thoughts; however, these symptoms disappeared after about five minutes.
Questions:
1.
Are these symptoms indicative of a disturbance of consciousness?
2.
Which specialty should be consulted? Is further brain examination necessary?
3.
Could this be a psychological illusion? If so, can it be overcome with willpower?

Hukou, 40~49 year old female. Ask Date: 2005/05/04

Dr. Ye Boshou reply Neurology

1.
Is your work too exhausting?
2.
What was your mental state at the time of the incident?
3.
Have you consumed coffee or any other stimulants?
4.
What is your sleep pattern like?
Based on these questions, it seems that there may be an unconscious disorder, possibly related to autonomic nervous system dysregulation.
Brain examinations such as CT, MRI, and EEG should be conducted, and the heart has already been evaluated.

Reply Date: 2005/05/04

More Info

Understanding consciousness disorders, particularly in the context of your symptoms, involves a comprehensive approach that considers both physiological and psychological factors. Based on your description, it appears that you have experienced a range of symptoms including tachycardia (rapid heartbeat), feelings of unreality (derealization), fatigue, difficulty concentrating, and episodes of dizziness. These symptoms can indeed be associated with consciousness disorders, but they may also overlap with anxiety disorders, panic attacks, or other psychological conditions.

1. Are these symptoms indicative of a consciousness disorder?
Yes, the symptoms you describe can be related to consciousness disorders, particularly if they involve alterations in awareness or perception. Derealization, for instance, is a dissociative symptom where one feels detached from their surroundings, which can be distressing and may accompany anxiety or panic attacks. The episodes of rapid heartbeat and shaking could also suggest a panic response, which is often tied to anxiety disorders. However, it is essential to differentiate between various conditions, as similar symptoms can arise from different underlying issues.

2. Which specialist should you consult, and are further brain examinations necessary?
Given your history and the persistence of your symptoms despite numerous tests, it would be prudent to consult a psychiatrist or a neurologist. A psychiatrist can help assess for anxiety disorders, panic disorders, or other mental health conditions that might be contributing to your symptoms. A neurologist can evaluate for any neurological conditions that might not have been detected in previous imaging studies. While you have undergone extensive testing, if your symptoms persist or worsen, further neurological evaluation may be warranted to rule out any underlying issues that could contribute to your symptoms.

3. Could this be psychological hallucination, and can it be overcome with willpower?
The term "psychological hallucination" typically refers to experiencing perceptions without external stimuli, which is more aligned with psychotic disorders. However, your symptoms seem more related to anxiety and dissociation rather than true hallucinations. While willpower can play a role in managing anxiety and stress, it is often not sufficient on its own to overcome psychological symptoms, especially if they are rooted in anxiety or panic disorders. Cognitive-behavioral therapy (CBT) is a highly effective treatment for anxiety and can help you develop coping strategies and address the underlying thought patterns contributing to your symptoms.

In summary, your symptoms warrant a thorough evaluation by a mental health professional who can provide a comprehensive assessment and appropriate treatment options. It is crucial to address both the psychological and physiological aspects of your experience, as they can be interrelated. Engaging in regular physical activity, such as running, is beneficial for overall mental health, but it should be complemented with professional support to effectively manage your symptoms. Additionally, consider discussing your experiences openly with your healthcare provider to explore tailored treatment options that may include therapy, medication, or lifestyle modifications.

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